Threats to the U.S. Safety Net
Kelly: There are many threats to the United States health care safety net. A few of these threats include members of Congress pushing to repeal portions of the Affordable Care Act, decreasing services available to Medicaid and Medicare beneficiaries, and creating requirements that make Medicaid coverage more difficult to obtain (Still Lurking: Federal Threats to Health Care, 2018). Despite hesitation from American citizens in 2017, members of Congress are still attempting to repeal portions of the ACA through a new version the Graham-Cassidy proposal (Still Lurking: Federal Threats to Health Care, 2018). This new version, Graham-Cassidy 2.0, would repeal portions of the ACA that require insurance companies to provide prescription coverage, maternity care, mental health care, and treatment for opioid addiction (Spiro, 2018). In addition, this bill would repeal the prohibition of insurance companies from charging higher premiums for pre-existing conditions and advancing age (Spiro, 2018). Additional threats identified include the cutting of services that support low-income families that rely on Medicaid and Medicare, and creating requirements that make Medicaid coverage more difficult to obtain (Still Lurking: Federal Threats to Health Care, 2018). Republican Speaker Paul Ryan supports these reform efforts, which would affect the work requirements for Medicaid, housing assistance, and nutrition programs (Still Lurking: Federal Threats to Health Care, 2018). The proposed work requirements require 20 hours of work per week or 80 hours of work per month to be eligible for Medicaid benefits (Ayanian, Tipireni, & Goold, 2018). These requirements are supported by the Trump administration’s Center for Medicare and Medicaid Services (CMS), and do not have provisions that assist low-income individuals with finding employment (Still Lurking: Federal Threats to Health Care, 2018). A final threat to the US health care safety net includes the American Health Care Act (AHCA). H.R. 1628 American Health Care Act of 2017, is a bill that was introduced by the House of Representatives in 2017 (Dobson, DaVanzo, & Haught, 2017). Similar to the attempted reforms by Congress regarding Medicaid, this Bill would make many changes to Medicaid. This proposed Bill would end the ACA’s Medicaid expansion, and reduce funding available to states (Dobson, DaVanzo, & Haught, 2017). The reduction in funding would threaten the financial status of safety-net hospitals, and it is estimated there will be an 83 percent reduction in the income for these hospitals (Dobson, DaVanzo, & Haught, 2017). Although this particular bill has sat dormant since May 2017 and has not passed the Senate, components still pose a threat to the United States healthcare safety net. The affordable care act continues to be up for reform as the government decides who the burden of funding and cost of tis Act fall on. According to Bodenheimer and Grumbach, the burden falls somewhere between individual private insurance, employment based insurance and government funding. Tricia: The United States health care system consists of a fluid approach between primary, secondary, and tertiary care. The focus of the United States has often relied on the more expensive tertiary care, with the health specialists providing rescue care for those with chronic illnesses (Bodenheimer and Grumbach, 2016). The Affordable Care Act (ACA) has shifted the focus to preventive medicine in primary care, with the intent of higher rates of people being insured. With the shift to preventive care, patient engagement has become a threat to maintaining this model. Patient engagement is required to prevent the utilization of tertiary care and managing health with less resources (Fleming, et al., 2017). Bodenheimer, T. S. & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York: McGraw Hill Fleming, M.D., Shim, J.K., Yen, I.H., Thompson-Lastad, A., Rubin, S., Van Natta, M., & Burke, N.J. (2017). Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net. Social Science & Medicine, 183, 11-18.